Citation Nr: 21076878 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 17-18 683 DATE: December 28, 2021 ORDER Service connection for bilateral hearing loss is denied. Service connection for a heart disorder, to include as due to in-service asbestos and/or chemical exposure, is denied. Service connection for obstructive sleep apnea, to include as secondary to a service-connected disability, is denied. FINDINGS OF FACT 1. Hearing loss of either ear did not manifest within one year of the Veteran's discharge from service and it is not shown to be causally or etiologically related to any disease, injury, or incident during service. 2. The Veteran has a current diagnosis of several heart disorders but such disorders are not shown to be causally or etiologically related to any disease, injury, or incident in service, to include any in-service chemical exposures and/or his presumed asbestos exposure. 3. The Veteran has a current diagnosis of sleep apnea, but such disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service, or caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385. 2. The criteria for service connection for a heart disorder are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Air Force from January 1976 to January 1980. This case comes on appeal to the Board of Veterans' Appeals (Board) from September 2014 and April 2017 decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. Specifically, the September 2014 rating decision, in part, denied service connection for bilateral hearing loss and a heart disorder. The April 2017 decision found that the Veteran had failed to submit new and material evidence to reopen a previously denied claim of entitlement to service connection for sleep apnea. The Veteran and his wife testified before the undersigned Veterans Law Judge at a Board videoconference in February 2020. A transcript of this proceeding has been associated with the claims file. This case was previously before the Board in May 2020 at which time the Board reopened the previously denied claim of entitlement to service connection for obstructive sleep apnea and remanded this issue, along with the hearing loss and heart issues, for additional development. General Legal Criteria Service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases, including organic diseases of the nervous system (i.e., hearing loss), will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Service connection for bilateral hearing loss is denied. The Veteran contends that he has bilateral hearing loss as a result of his in-service noise exposure. Specifically, the Veteran testified that he was exposed to significant weapon noise during his military service such as jet aircraft/engine noise while working as a radio operator and driver while working in Texas and Korea. The Veteran's service personnel records show that he had military occupational specialties (MOSs) during service of ground radio communications specialist as well as tactical air command and control specialist. As such, in-service noise exposure has been established. For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385; see also Hensley v. Brown, 5 Vet. App. 155, 157 (1993) (noting that the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss). The Veteran's service treatment records (STRs) are negative for hearing loss and generally show an increase in hearing acuity in the right ear but a decrease in acuity in the left ear when comparing audiological readings from the Veteran's September 1975 enlistment examination to his October 1979 separation examination. Specifically, the September 1975 enlistment examination shows the following puretone thresholds: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Right Ear 5 dB 15 dB 15 dB 5 dB Left Ear 5 dB 15 dB 15 dB 15 dB The October 1979 examination shows the following puretone thresholds: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Right Ear 5 dB 5 dB 10 dB 5 dB Left Ear 10 dB 10 dB 20 dB 15 dB In March 2014, the Veteran submitted an initial claim for service connection for bilateral hearing loss. In connection with this claim and pursuant to the May 2020 Board remand, he was afforded a VA audiological examination in June 2020 which shows the following puretone thresholds: 1000 Hz 2000 Hz 3000 Hz 4000 Hz Right Ear 35 dB 35 dB 40 dB 45 dB Left Ear 35 dB 40 dB 45 dB 50 dB Speech Recognition was 96 percent for the right ear and 96 percent for the left ear. Significantly, the June 2020 VA examiner diagnosed bilateral sensorineural hearing loss and opined that the Veteran's bilateral hearing loss is less likely than not due to his military service. As rationale for this opinion, the examiner noted that there is no significant permanent shift in hearing thresholds beyond test variability from entrance to separation, which is objective evidence of no permanent auditory damage on active duty from conceded noise. Furthermore, there is no report of complaint/treatment for hearing decrease in the Veteran's STRs or at separation. According to the June 2020 VA examiner, the Veteran reported an onset of hearing decrease in the "mid-1980s," five years post-separation, but the earliest VA record of hearing loss is in 2015, 35 years post-separation. In addition, the Veteran had significant excessive occupational noise exposure in his construction work from 1977 to 2003 (drywall and metal stud frames). Although in-service noise exposure is conceded, and the relationship between noise exposure, auditory damage, and hearing loss is well-established, auditory damage and hearing loss are not conceded based on in-service noise alone. There was no evidence or complaint of hearing loss within a reasonable time post active duty. Also of record are VA and private treatment records dated through October 2021 which show treatment for the Veteran's bilateral hearing loss but do not provide any additional insight into the etiology of his bilateral hearing loss. Upon review of the above evidence, the Board finds that the probative evidence of record fails to show a link between the Veteran's in-service noise exposure and his current bilateral hearing loss. As above, the June 2020 VA audiological examination shows bilateral hearing loss for VA compensation purposes pursuant to 38 C.F.R. § 3.385. As such, the first criteria of service connection, a current disability, have been met. As to the second criteria of service connection, in-service incurrence or aggravation of a disease or injury, the Board notes that in-service noise exposure has been conceded given the Veteran's MOSs of ground radio communications specialist as well as tactical air command and control specialist have a high probability of noise exposure. As such, the second criteria of service connection have been met. However, the third criteria, a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service, have not been met. As above, the June 2020 VA examiner reviewed the claims file, interviewed the Veteran, and performed an audiological examination. The examiner specifically noted the Veteran's normal audiological evaluations during service, his history of noise exposure during and after service, and opined that it was less likely than not that hearing loss is related to military service. Significantly, the examiner noted that there was no threshold shift in the Veteran's in-service audiological testing and that, while the Veteran did have some in-service noise exposure, he had even greater and longer post-service noise exposure. The Board accords great probative weight to the June 2020 VA examiners' opinion as the opinion contains clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). There is no contrary medical opinion of record. The Board notes that the Veteran has contended on his own behalf that his hearing loss is related to his military service. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F. 3d 1313, 1316 (Fed. Cir. 2009). However, "VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to." Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the question regarding the potential relationship between the Veteran's hearing loss and any instance of his military service, to include his exposure to noise, to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (providing that although a veteran is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, a veteran is not competent to provide evidence as to more complex medical questions). Therefore, while the Veteran is competent to describe his in-service noise exposure and his current problems regarding difficulty hearing, he cannot, as a layperson, provide competent medical evidence establishing a connection between his current hearing loss and his in-service noise exposure. In this regard, assessing the impact noise has on an individual's ability to hear involves consideration of the way humans process noise and the type, frequency, and volume of noise exposure. There is no indication that the Veteran possesses an expertise in such area. Moreover, he has offered only conclusory statements regarding the relationship between his in-service exposure to noise and his current bilateral hearing loss. Therefore, as the June 2020 VA examiner possesses the expertise necessary to identify the relevant factors to consider in assessing causality and provided an opinion in consideration of all of the relevant evidence, the Board accords great probative weight to this opinion. As such, it is not outweighed by the lay opinion asserted by the Veteran. Furthermore, there have been no allegations of a continuity of hearing loss symptomatology since service. Significantly, during the June 2020 VA examination, the Veteran reported an onset of hearing decrease in the "mid-1980s," five years post-separation. Moreover, the record fails to show that the Veteran manifested hearing loss within the first year following his active duty service discharge in January 1980. As such, presumptive service connection, to include on the basis of continuity of symptomatology is not warranted for hearing loss. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309; Walker, supra. Based on the foregoing, the Board finds that service connection is not warranted for bilateral hearing loss. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service connection for a heart disorder, to include as due to in-service asbestos and/or chemical exposure, is denied. The Veteran contends that he has a heart disorder secondary to in-service asbestos and/or chemical exposure. Specifically, he contends that he was exposed to asbestos by breathing in the air at his barracks at either Bergstrom Air Force Base in Austin, Texas and/or Camp Red Cloud in Korea. He also contends that he was exposed to harmful solvents to clean antennas and spray paint vehicles during his service as a ground radio communication specialist and/or tactical air command and control specialist. Based on a review of the Veteran's military records, specifically his MOS of radioman, VA conceded that the Veteran was exposed to asbestos while in service in an October 2021 supplemental statement of the case. There is no specific statutory guidance with regard to asbestos-related claims, nor has the Secretary of VA promulgated any specific regulations. However, in 1988, VA issued a circular on asbestos-related diseases that provided guidelines for considering asbestos compensation claims. See Department of Veterans Benefits, Veterans' Administration, DVB Circular 21- 88-8, Asbestos-Related Diseases (May 11, 1988). Also, an opinion by VA's Office of General Counsel (OGC) discussed the proper way of developing asbestos claims. See VAOPGCPREC 4-2000 (Apr. 13, 2000). VA recognizes some of the major occupations involving exposure to asbestos include mining, milling, shipyard work, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products (such as clutch facings and brake linings), and manufacture and installation of products such as roofing and flooring materials, asbestos cement sheet and pipe products, and military equipment. Asbestos fiber masses have a tendency to break easily into tiny dust particles that can float in the air, stick to clothes, and may be inhaled or swallowed. Inhalation of asbestos fibers can lead to a non-exclusive list of asbestos-related diseases/abnormalities: fibrosis (the most commonly occurring of which is interstitial pulmonary fibrosis, or asbestosis), tumors, pleural effusions and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, and cancers of the lung, bronchus, gastrointestinal tract, larynx, pharynx, and urogenital system (except the prostate). The guidelines provide that the latency period for asbestos-related diseases varies from 10-45 years or more between first exposure and development of disease. The extent and duration of exposure to asbestos is not a factor for consideration. Thus, an asbestos-related disease can develop from brief exposure to asbestos or as a bystander. The guidelines further provide, in part, that the clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal disease. Rating specialists must develop any evidence of asbestos exposure before, during, and after service. A determination must be made as to whether there is a relationship between asbestos exposure and the claimed disease, keeping in mind the latency period and exposure information. The adjudication of a claim for service connection for a disability resulting from asbestos exposure should include a determination as to whether: (1) service records demonstrate the Veteran was exposed to asbestos during service; (2) development has been accomplished sufficient to determine whether the Veteran was exposed to asbestos either before or after service; and (3) a relationship exists between exposure to asbestos and the claimed disease in light of the latency and exposure factors. The Court has held that VA must analyze an appellant's claim for service connection for asbestosis or asbestos-related disabilities under the appropriate administrative guidelines. Ennis v. Brown, 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993). If the evidence supports a conclusion that the Veteran's current disability, while caused by asbestos exposure, is due to intervening post-service exposure, the opinion must be very specific explaining the basis for this finding. See McGinty, supra. The Veteran's STRs are negative for heart problems. Significantly, the Veteran's October 1979 separation examination shows a normal heart and, in an October 1979 report of medical history, the Veteran specifically denied "pain or pressure in chest" as well as "heart trouble." Post-service treatment records show that the Veteran was found to have minimal mitral stenosis in February 2003 and underwent mitral valve replacement in June 2003. The Veteran submitted an initial claim for service connection for a heart disorder in March 2014. During the February 2020 Board hearing, the Veteran testified that his private cardiologist, Dr. F., told him that his post-service mitral valve problems could have been caused by in-service asbestos exposure. In connection with the Veteran's claim and pursuant to the May 2020 Board remand, he was afforded a VA heart examination in September 2020. Significantly, the examiner diagnosed valvular heart disease, heart valve replacement, cardiomyopathy, implanted automatic implantable cardioverter defibrillator, and paroxysmal atrial fibrillation. The examiner then opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As rationale for this opinion, the examiner noted that the composition of the "antennae cleaner" noted by the Veteran is unknown, making an opinion about the effects of its exposure not possible. With regard to the Veteran's presumed asbestos exposure, the examiner noted that, in some rare events, asbestos exposures have been shown to be linked to certain cardiac conditions. However, medical literature is silent for any of the Veteran's diagnosed heart disabilities, specifically, to be caused by asbestos exposures. With regard to the Veteran's diagnosed mitral insufficiencies, the September 2020 VA examiner noted that etiologies of mitral stenosis have been identified in literature to be rheumatic fever; calcium deposits, and, in rare cases, congenital defects, radiation to the chest, and some autoimmune diseases, such as lupus. Other etiologies such as infective endocarditis, mitral annular calcification in elderly patients, congenital malformation (parachute mitral valve), systemic lupus erythematosus, carcinoid heart disease, endomyocardial fibrosis and rheumatoid arteritis are representing less than 10 percent of adult cases. Given the paucity of evidence to demonstrate asbestos or antennae cleaning fluid exposure as the etiology of the mitral insufficiencies, the claimed condition less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. References: https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-mitral-valve-stenosishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727554/. With regard to the Veteran's diagnosed cardiomyopathy, the September 2020 VA examiner noted that medical literature is silent for cardiomyopathy, specifically, to be caused by asbestos exposures. Etiologies of cardiomyopathy have been identified in literature to be: a family history of heart disease; sudden cardiac death, or cardiomyopathy; high blood pressure; coronary artery disease; amyloidosis and sarcoidosis, which can damage the heart; viral infections of the heart; diabetes; alcohol use disorder; and some women can have a higher risk of cardiomyopathy after pregnancy. Given the paucity of evidence to demonstrate asbestos or antennae cleaning fluid exposure as the etiology of the Veteran's cardiomyopathy, the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. References: https://www.medicalnewstoday.com/articles/327456#causes-and-risk-factors With regard to the Veteran's diagnosed implanted automatic implantable cardioverter defibrillator, the September 2020 VA examiner noted that indications for an implanted automatic implantable cardioverter defibrillator are usually found where the patient has already suffered and survived cardiac arrest due to ventricular fibrillation/ventricular tachycardia, or primary when the patient is at high risk of sudden cardiac death due to VF/ VT but has never had any such event. Secondary prophylaxis usually involves event of cardiac arrest due to ventricular fibrillation (VF) or hemodynamically unstable, also known as pulseless, ventricular tachycardia (VT). Adequate workup and exclusion of reversible causes should be done first before deciding to put the device in, as is endorsed by the guidelines laid down by Heart Rhythm Society (HRS) and American College of Cardiology (ACC). Given the paucity of evidence to demonstrate asbestos or antennae cleaning fluid exposure is the etiology of the Veteran's implanted automatic implantable cardioverter defibrillator, the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. References: https://www.ncbi.nlm.nih.gov/books/NBK538341/ With regard to the Veteran's diagnosed paroxysmal atrial fibrillation, the September 2020 VA examiner noted that medical literature is silent for a connection between paroxysmal atrial fibrillation and asbestos exposures. Etiologies of paroxysmal atrial fibrillation have been identified in literature to be: non-cardiac causes: chronic lung disease, pulmonary embolism, electrolyte abnormalities, acute infections, thyroid disorders, pheochromocytoma, and hypothermia, post-surgical (seen in 35 to 50 percent of patients post coronary artery bypass graft). Given the paucity of evidence to demonstrate asbestos or antennae cleaning fluid exposure is the etiology of the Veteran's paroxysmal atrial fibrillation, the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. References :https://www.ncbi.nlm.nih.gov/books/NBK535439/ Also of record are VA and private treatment records dated through October 2021 which show treatment for the Veteran's heart disorders but do not provide any additional insight into the etiology of his heart disorders. Upon review of the above evidence, the Board finds that service connection for a heart disorder is not warranted. Initially, the Board notes that none of the Veteran's diagnosed heart disorders are included as a chronic condition under 38 C.F.R. § 3.309(a). As such, presumptive service connection is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309; Walker, supra. The claim is also denied on a direct basis. As above, STRs are negative for an indication of a heart disorder. The earliest indication of a heart disorder is the Veteran's February 2003 diagnosis of minimal mitral stenosis, approximately 23 years after his discharge from service. Such a lapse of time is a factor for consideration in deciding a service connection claim. Maxson v. Gober, 230 F.3rd 1330, 1333 (Fed. Cir. 2000). Furthermore, the September 2020 VA examiner opined that the Veteran's heart disorders were not related to an incident of the Veteran's active military service, to include his presumed exposure to asbestos. Significantly, the September 2020 VA examiner noted that there was no medical literature relating the Veteran's heart disabilities with asbestos exposure. The Board accords great probative weight to the September 2020 VA examiners' opinion as the opinion contains clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez, 22 Vet. App. at 295 and Stefl, 21 Vet. App. at 124. With regard to the Veteran's February 2020 testimony that his private cardiologist, Dr. F., told him that his post-service mitral valve problems "could" have been caused by in-service asbestos exposure, the Veteran has not submitted a statement from Dr. F. corroborating this nexus. Moreover, finding that the Veteran's mitral valve problems "could" have been caused by in-service asbestos exposure does not meet the necessary standard in this case that such a relationship was at least as likely as not. Rather, it is too speculative to base a connection on. As such, the Board finds the September 2020 VA medical opinion to be more probative with regard to this matter. While the Veteran has alleged that a heart disorder is related to his military service, the Board finds that the question regarding the potential relationship between the Veteran's heart disorders and any instance of his military service to be complex in nature. Woehlaert, 21 Vet. App.at 462. Furthermore, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). In this regard, the question of causation of the Veteran's heart disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence. Accordingly, for the reasons stated above, the Board finds that the preponderance of the evidence is against the claim for service connection for a heart disorder. As the evidence is not in relative equipoise, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Service connection for obstructive sleep apnea, to include as secondary to a service-connected disability, is denied. The Veteran contends that service connection is warranted for obstructive sleep apnea, to include on either a direct or secondary basis. The Veteran's STRs are negative for any indication of sleep apnea. Significantly, the Veteran's October 1979 separation examination shows normal "lungs and chest" and, in an October 1979 report of medical history, the Veteran specifically denied "shortness of breath" as well as "frequent trouble sleeping." Post-service private treatment records show that he underwent a sleep study and was diagnosed with obstructive sleep apnea in Apri 2006. The Veteran submitted an initial claim for service connection for various disabilities, to include sleep apnea, in May 2014. In a September 2014 rating decision, the RO denied service connection for sleep apnea on a direct basis, finding that there was no evidence of such within one year of the Veteran's discharge from service and no nexus between this disorder and the Veteran's military service. The Veteran did not appeal the denial. The Veteran submitted the current claim for service connection for sleep apnea in April 2017, this time contending that such disability is secondary to his claimed heart disorder. Specifically, during the February 2020 Board hearing, the Veteran testified as to his belief that his sleep apnea was secondary to and/or aggravated by his heart disorder as he first experienced heart problems in 2002/2003 and was diagnosed with sleep apnea in 2006. The Veteran's wife also testified that, after the Veteran's 2003 heart surgery, he began experiencing breathing cessation during his sleep, a symptom of sleep apnea. As above, in May 2020, the Board reopened the Veteran's previously denied claim of entitlement to service connection for obstructive sleep apnea and remanded this claim as inextricably intertwined with the remanded heart issue. Also of record are VA and private treatment records dated through October 2021 which show treatment for the Veteran's sleep apnea but do not provide any additional insight into the etiology of his sleep apnea. Initially, the Board has considered whether service connection is warranted on a presumptive basis. However, sleep apnea is not listed as a presumptive condition under 38 C.F.R. § 3.309. As such, presumptive service connection is not warranted pursuant to 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The claim must also be denied on a direct basis. As above, STRs are negative for sleep apnea symptoms and the Veteran does not contend that such began in service. In fact, a review of the record shows that his sleep apnea did not begin until 2006, approximately 26 years after his discharge from military service. With regard to the Veteran's claim for service connection sleep apnea as secondary to a heart disorder, the Board notes that service connection for a heart disorder is not in effect. Therefore, service connection for sleep apnea on a secondary basis is also not warranted. While neither a VA examination nor medical opinion has been obtained with regard to this issue, the Board finds that the threshold criteria under McLendon v. Nicholson, 20 Vet. App. 79 (2006) for obtaining an examination and/or medical opinion have not been met. Significantly, a conclusory generalized lay statement alleging nexus between a current disability and service does not meet the standard to warrant a VA examination. Waters, 601 F.3d at 1278-79. That is all there is in the present case. The Veteran claims that service connection is warranted for sleep apnea, but did not submit evidence or make lay statements indicating that he had persistent or recurrent symptoms of the disability or that he had symptoms in and since service. Thus, a VA examination under McLendon is not warranted. As the Board finds that the preponderance of the evidence is against this claim, the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.§ 5107. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board April Maddox, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.